Diabetes Prevention Program
California state law requires the Department of Health Care Services (DHCS) to establish the Diabetes Prevention Program (DPP) as a Medi-Cal covered benefit. Medi-Cal's DPP benefit will be consistent with the federal Centers for Disease Control and Prevention's (CDC's) guidelines and will also incorporate many components of the Centers for Medicare & Medicaid Services' (CMS') DPP in Medicare.
The DPP is an evidence-based, lifestyle change program designed to assist Medi-Cal beneficiaries diagnosed with prediabetes in preventing or delaying the onset of type 2 diabetes. Medi-Cal providers choosing to offer DPP services must comply with CDC guidance and obtain CDC recognition in connection with the National Diabetes Prevention Recognition Program (DPRP). DPP services will be provided through trained peer coaches who use a CDC-approved curriculum.
Medi-Cal's DPP will include a core benefit consisting of at least 22 peer-coaching sessions over 12 months, which will be provided regardless of weight loss. In addition, beneficiaries who achieve and maintain a required minimum weight loss of 5 percent from the first core session will also be eligible to receive ongoing maintenance sessions, after the 12-month core services period, to help them continue healthy lifestyle behaviors. The CDC's DPP curriculum promotes realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.
- DHCS and CDPH presented information about the Medi-Cal DPP benefit at the quarterly Prevent Diabetes STAT webinar on
February 25, 2019.
The following are state-generated resources and reference materials for beneficiaries and providers regarding Medi-Cal's DPP benefit:
- *UPDATED* Frequently Asked Questions: DHCS' responses to commonly asked questions regarding Medi-Cal's DPP benefit.
- Coverage and Reimbursement Policy: Please refer to the Medi-Cal DPP coverage and reimbursement policy for information about the new DPP benefit. Please note that once the necessary fee-for-service (FFS) systems edits are complete, this information will be finalized and published in the Medi-Cal Provider Manual. At that time, Medi-Cal FFS providers may begin submitting and billing for DPP services; however, in the interim, Medi-Cal FFS providers are instructed to hold all DPP claims under further notice from the Department. To ensure providers stay up-to-date concerning important DPP information, the Department encourages providers to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to the upcoming changes. Providers may sign up for MCSS by completing the MCSS Subscriber Forms.
- Managed Care All Plan Letter: The All Plan Letter provides guidance specifically for Medi-Cal Managed Care Plans and is not intended for Medi-Cal DPP providers.
- DPP Curriculum Translations: DHCS is working to translate the CDC-approved curriculum into DHCS' required threshold languages. Once finalized, DHCS will publish the translated materials on the DHCS website. The National Association of Chronic Disease Director's National DPP Coverage Toolkit now includes the National DPP Curriculum and its various translations.
- Assembly Bill 1810 (Committee on Budget, Chapter 34, Statutes of 2018)
- Senate Bill 97 (Committee on Budget, Chapter 52, Statutes of 2017)
- DPP Mailbox: If you have any questions about Medi-Cal's DPP, please email DHCSDPP@dhcs.ca.gov.
The following are federally generated DPP resources and reference materials for beneficiaries and providers: